Success and Procedural Outcome of Excimer Laser Coronary Angioplasty Compared to Conventional Balloon Angioplasty

BACKGROUND: Coronary excimer laser angioplasty was suggested to be superior for treatment of lesions with complex lesion morphology. METHODS: In this study, 134 consecutive patients undergoing excimer laser angioplasty (ELCA) were compared to 203 patients treated with conventional balloon angioplasty (PTCA) in the same study period. Baseline characteristics did not differ between both groups except the distribution of target vessel (LAD: ELCA 72% vs. PTCA 50%). RESULTS: In the ELCA group, 64 of 139 lesions required adjunctive balloon angioplasty. Overall procedural success was achieved in 80% of patients treated with PTCA and in 78% of patients treated with ELCA (NS), as defined by a reduction of at least 20% of the luminal narrowing and ² 50% residual stenosis, and no in-hospital complication. Complications included acute vessel closure (ELCA: 23.7%, PTCA 6.9%; NS), myocardial infarction (ELCA: 3.6%, PTCA 1.7%; NS), emergency bypass surgery (ELCA: 0%, PTCA 0.5%; NS), and death (ELCA: 2.2%, PTCA: 0.5%; NS). No significant difference was found between the acute success rates and major complications in either A, B1, B2 and C lesions (modified ACC/AHA Task Force classification) treated with ELCA as compared to PTCA. A trend toward increased success rates were documented for ELCA of total and functional occlusion (ELCA: 86% vs. PTCA: 57%; NS) and bifurcational or ostial lesions (ELCA: 95% vs. PTCA 78%). CONCLUSIONS: Further randomized trials are needed to compare the acute success of excimer laser treatment with balloon angioplasty for these selected lesion types.